Was it really Depression... or Undiagnosed OSAH??

[SleepyHibiscus]

Hi everyone in CPAP land! I am very interested to hear from anyone that had a similiar experience to mine. I am 48 yr old female, diagnosed 15 yrs ago with depression. Symptoms presented were fatigue, excessive daytime sleepiness, poor sleeping, frequent nocturnal awakenings, poor daytime concentration, difficulty making decisions, brain fog, weight gain, anxiety, general malaise, body aches. Was given many antidepressants starting with Prozac, Paxil, Effexor, Lexapro, Zoflot, & currently taking Cymbalta. All seemed to contribute to more sleepiness. All docs agreed it was depression with anxiety. But I saw a different one 2 wks ago, actually a nurse practitioner. She recommended a complete sleep evaluation to find the cause, not just offer a bandaid. I had 2 studies, 2nd one with CPAP and it was confirmed I have moderate OSAH. I am relieved to know I can finally attempt to regain the quality of my life. I grieve the loss of many years that I was in a fog and not fully functioning. I think I was misdiagnosed and overmedicated, but ready to move forward.

Has anyone experienced this? If so, has your depression gone away? Has CPAP helped you? I belive mine is from my small bone structure and small airway. I think I will do well with a small mask, so long as it is quiet and diffuses the air far away from my face. I like to bury into my pillow, on my side and also roll onto my back sometimes. I would love to hear your suggestions before I meet with a DME next week!

Thank you for listening and God Bless.
Sleepy Hibiscus in TX

[LDuyer]

Hi Sleepy!

I was not treated for depression but I sure had it. And I've read about many people being treated for depression when their depression was all due to their undiagnosed and untreated sleep apnea. That does not mean that some people have both sleep apnea and clinical depression, but many people are misdiagnosed. Reading your list of symptoms, wow, they were entirely sleep apnea symptoms. I think it's wrong that the mental health profession does not push to identify possible physical causes of exhaustion. I'm so glad you are not diagnosed. I suspect you will do well once you start cpap therapy.

Thinking of what you wrote, I was reminded of something I recently read:

Women and Sleep Apnea
Women with obstructive sleep apnea are more likely to be treated for depression and to have insomnia and hypothyroidism than men with the same degree of obstructive sleep apnea, according to a study published in the March issue of the journal Sleep, the official publication of the Associated Professional Sleep Societies. The study found that men diagnosed with obstructive sleep apnea are more likely to have a history of apnea (witnessed by a spouse or family member), consume more caffeinated beverages and admit to greater alcohol consumption. "We used to think apnea was rare in women. We now know that is not true; instead it may be that women seem to be underdiagnosed or misdiagnosed," says Dr. Meir Kryger, director of the Sleep Disorders Center at St. Boniface General Hospital in Winnipeg, Canada, who coauthored the study. "Women with apnea were much more likely than men with apnea to be treated for depression—a condition they may not have—and were more likely to have insomnia. Thus it appears that when a doctor is confronted by an overweight, sleepy woman, the doctor is more likely to suspect depression in a woman than a man, and miss the correct diagnosis."

This was from Newsweek Health: http://msnbc.msn.com/id/7077622/site/newsweek/

Good luck to you.


Linda

[Guest]

Yes when i was 20 i was diagnosed with depression...much like you were...then after 5 years after having tried over 12 differnt medications for it and being labeld as an untreatable depressive someone finally suggested sleep disorders....Bingo!!!! I am now off medication although that was no easy task...i tried several times with different methods to gett of of them with no luck..i was severly addicted to them and went in to withdrawl compairable to meth withdrawl or narcotics...finally i found an organization that specialized in getting off antidepressants. I dont know what this websites policy on posting other sites is so email me if you want the site infomation. You may get worsening depression even if you didnt have it to start with when you try to stop the medication because that is one of the side effects and withdrawl symptoms that can last for years if you do not take care of them properly. You can do this program at home and it doesnt interupt your life at all...i could not have done it otherwise with kids to take care of.
So yea i never needed medication.......grrrrr
yellowcason@gmail.com

It wont let me log in...any one else having that problem?

[Roger E.]

I am a male and my story is very much like yours.

For six years I was treated for depression and anxiety. In rotation I was given one beta blocker, two sleeping medications, two muscle relaxants, three antidepressants and even an antihistamine. Every medicine made my condition worse and added some nasty side effects.

I was sent to talk therapy and put on a strict diet/exercise/sleep hygiene program with a daily log. This did not hurt me but it made my "depression" no better.

Then my therapist started to dig into my childhood and over several sessions made a small incident seem traumatic and even had me feeling sorry for myself as a young child. But nothing made me feel better - I was getting worse.

I quit the therapist and all doctors and all drugs for 8 months and carefully observed my symptoms. I finally became suspicious of apnea and had a sleep study confirm severe obstructive sleep apnea. I immediately started cpap therapy.

I was so sick for so long I feel like it may take a year or two to recover. I am not completely clear of the depression and anxiety but I am still fiddling with masks, humidification levels and sleeping habits. I hope to eventually have the cpap working well and fully expect to never take another drug for a mental condition.

I have contacted all of my doctors and my therapist and told them in no uncertain terms what was wrong with me and that they should screen any patients with any of my symptoms for sleep apnea.

I wonder how many other patients they treated like me?

I am glad you finally got to the root of your problems. Too bad it took so long.

[OSAGuy]

I was treated for depression for a couple of years and had awful reactions to all of the medications - Usually after being on one for a couple of months. During this time my Dr. said he strongly suspected that I had sleep apnea. After a year of his suggestions I had the sleep study done and sure enough, severe sleep apnea. Immediately got the APAP. Started using it regularly and fealt much better. Also started exercising regularly and no more depression. About 1 1/2 years on APAP I got off blood pressure medication entirely. Typical BP is now in the 125/65 to 130/170 range - Not bad for a 52 year old! That's along answer to your question, but the bottom line is that yes, sleep apnea can be related to the symptoms you refer to - It is well documented in most articles about sleep apnea, although the pharmaceutical industry would just as soon have you believe that the only way to treat depression is through their medications. Don't get me wrong, those medications do serve a very useful purpose, but the solution is not always in a pill.

[sleepypirate555]

I'm bipolar, but I wasn't treated or correctly diagnosed until this past year. In fact it was my psych. Nurse pract. That first told me that my excessive tiredness might actualy be something physical. She was the one who practically forced my doctor to refer me to the sleep clinic. I was treated for depression (which I don't have)for YEARS. My doc (a new one) did tell me however that once the cpap works I may have much less bipolar problems. Yay! Anyway just wanted to say, you aren't alone. My tiredness was attributed to me being lazy, or just having emotional problems. We women need to be forceful with our docs!

[Jere]

Sounds like my story. I was treated with meds for depression for years, but nothing worked well (one almost killed me) and all contributed to my life-long insomnia. I finally got completely fed up and insisted that all my docs get together and figure out what was going on. It was decided that I was probably not depressed but suffering from a mild bi-polar problem (inherited from my mom's side) and was also tested for sleep issues. These days I am on lithium and CPAP and feeling better that I have for years. The depression is not gone (It comes less frequently) and my 20-years of sleeping problems have all but disappeared (partly as a result of xpap therapy).

So hang in there. xpap may not be the golden ticket, but it should give you one more weapon to deal with the depression symptoms.

By the way there are lots of threads on this subject on this board, so you are definitely not alone.

Jere

[lvehko]

I could have written your post a few months ago -- very similar experience, and I too had hopes that treatment for CPAP would cure my depression. What I've discovered -- and keep in mind that I am only a couple of months into my CPAP treatment, so this could very well change with time -- is that now I can differentiate better between what is depression and what is simple fatigue, which has helped my shrink treat my depression more effectively. There *is* a strong correlation between depression and apnea, but what I've read about it indicates that the two conditions often exist concurrently, and less often masquerade as each other... in short, for me, some of the symptoms I put down to depression were actually caused by the apnea, but treating the apnea didn't cure my depression. It did, however, make my depression treatment more effective, so in that sense the CPAP has been enormously helpful for my overall mental health. There are a lot of threads on this topic in the forum, and a lot of different experiences -- here's hoping yours turns out to be a beneficial one as well!

Minerva

[kevder]

My situation sounds very similar to all of yours, except in reverse. I was diagnosed with sever sleep apnea a couple of years ago. I tried various CPAP type treatments (CPAP, APAP, BiPAP) for two years with out any improvement. In fact, I started doing worse. I ended up with insomnia and averaged only two - three hours of sleep per night. The rest of the time I was up wondering around my house. My sleep doc had me try all sorts of different sleeping pills to get me to sleep at night and stimulants to keep me a wake during the day. Nothing seemed to work. The sleep doc finally said "Maybe you have depression, we don't deal with that. You need to find someone else." Well, I talked with my regular doc and long story short, was diagnosed with sever clinical depression. I was put on antidepressants and finally started showing some improvement. I do have sleep apnea but now I'm able to be compliant with the treatment. The moral of the story: Are you depressed because you are not sleeping well or are you not sleeping well because you are depressed? There is a difference and either way is easy to misdiagnose for the other.

[SleepyHibiscus]

Kevder wrote: I was put on antidepressants and finally started showing some improvement. I do have sleep apnea but now I'm able to be compliant with the treatment. The moral of the story: Are you depressed because you are not sleeping well or are you not sleeping well because you are depressed? There is a difference and either way is easy to misdiagnose for the other.

I absolutely agree... depression and sleep apnea, they tend to go hand in hand. So much so, that medical professionals need to be more educated to the fact that sleep apnea is often missed when evaluating patients who present symptoms of depression, and it is much more common than they think. You do not have to match a certain "typical" criteria to have apnea... you don't have to be a big guy, you can be a small lady like me with a very narrow airway. Best wishes to get the right meds for your depression and to become 100% compliant with cpap.

[josh]

Hi Sleepy,

I have a very similar story. I was in the Navy between 1997 and 2000. I was supposed to be in for 6 years, not 3, but I had left due to a "personality disorder". I was diagnosed with depression...particularly Generalized Anxiety Disorder...and that was that. Generalized, huh?

For symptoms I had thoughts of suicide, I was generally depressed, obviously alwasy fatigued, extremely anxious, could not concentrate, make descions, poor memory, and the list goes on...

So I began seeing a psychologist, and after a few sessions with her she turned me over to a psychiatrist, and that she couldn't help me. (Just as the Navy docs couldn't help me). So then I saw two psychiatrists (a married couple), and thats when the onslaught of medications began.

I don't know if I remember all of them, but I was on cymbalta, wellbutrin, viagra (once), provigil, ambien, celexa, alprozalem, klonipin and others I am sure.

And yet nothing seemed to work. Go figure.

So then I hit my head at work, literally, and saw the company nurse. She happened to have a side job as a sleep tech, and that was when I learned about sleep apnea.

And now, of course I still have probelms, but at least I have been med free for a year now! So what's the culprit? Severe OSA...

I'm going for a nap...

[Charina]

Sleepy Hibiscus,

Wow, very similar story. It’s been 17 years since I had my first major depressive episode. It’s been 14 years since I was diagnosed and started Prozac. It helped some, but not enough. So then Paxil, then Wellbutrin, then Zoloft. I found some solace with Zoloft after playing with timing of dosing for a while. The doc’s told me I was mistaken, but I knew that life was better when I took Zoloft at night rather than in the AM. After 10 years, I couldn’t stand the fog, weight gain, and fatigue any longer, there needed to be a change!

Docs should have diagnosed my apnea many years ago. Excessive fatigue, high blood pressure, enlarged heart, morning headaches, etc, etc. I wish – oh I wish that someone had rescued me from wasting so many years of my life! I could be so much more had I not been stuck in the fog.

It wasn’t until the fall of 2004 that I finally made the connection between sleep and depression. Looking back on my life, I noted that the times that I was most depressed were the times I got the least sleep.

I served a two year mission for my church, and worked my little tail off. I loved the work! But I was so depressed I was sent home 8 month into it. That’s when I started the Prozac. My return to normalcy at the time was attributed to Prozac, but really, was I finally able to sleep an adequate amount to compensate for OSA. Once I was back in the mission field, the depression returned. I was only getting 8 hrs of sleep, and with the OSA, I needed more.

For several years, I used to love Mondays. Everyone else around me hated Mondays. But I loved to work Mondays even though I didn’t really like my work. It wasn’t until years later that I realized that it probably was because I got enough sleep on the weekend that I felt OK, but by Friday, I was so depressed I didn’t care to do any work – only 7-8 each week day night.

And, in ’02, I was out of work for three months. WOW. By the end of those three months, I felt better than I had in a LONG time. So, from then on out, I put a lot of focus on getting to bed early every night. I always shot for 10 hrs, and knew the more I go the better. But, with a wife and two kids – getting 10 hrs in any one night was a miracle. Life struggled on with significant depression.

When I finally realized the correlation between sleep and depression, I saw the Doc immediately. He blew me off. I found a new doc and presented it to him, and a sleep study found I had moderate OSA. CPAP didn’t help – I tried it for more than 2 months without success – it just didn’t lower my AHI to where I had to have it.

After surgeries, and now on CPAP for 8 months, I’m starting to wake up from the depression. I’m still on anti-depressants – Cymbalta now. But, when I have a good nights sleep, the world is a whole different deal. Some days I can’t help but think depressing thoughts while getting ready for the day, and to a lesser degree all through the day. Other days, I can think clearly, can rationally dismiss depressing thoughts, and feel alive. The bad days are when my AHI is 3 or greater. The great days are when my AHI is below 2.5.

Is sleep my only problem? I dunno. That is yet to be determined. I think that being sleep deprived for so, so long, it is taking me quite a while to recoup fully. Plus, I have yet to figure out how to get a consistent AHI below 2.5. Once the sleep is under control, I’ll address the issue of whether or not depression exists in and of itself, or is simply a symptom of chronic sleep problems. But, for me, depression cannot be resolved without resolving the sleep issue.

Hang in there Sleepy Hibiscus. It may take a while. That was tough for me to come to grips with. I was so hoping for a magical awakening that would sweep away my problem. It has taken time and serious effort to figure out the whole CPAP thing, what masks work, play with pressures, etc, etc. Keep at it and don’t give up!

Ryan

[Offerocker]

My Clinical Depression was finally diagnosed and treated 10 years ago with Prozac. That first pill was like a miracle! I actually visualized what was happening; invasive thoughts were 'derailed', and MY thoughts remained "on track". I was able to concentrate better, and had fewer second-guessing (that I had no control over). There were many side-effects to the med, but I endured them to continue with the relief. Years later, the magic pill didn't seem to be working. I now believe that even though it helped with the Serotonin uptake, I had adjusted/learned to block the invasive thoughts on my own. I still had mood/sensitivity problems though.
I also was Rx with Clonazepam/Klonipin for PLMD and a deeper sleep. That worked, is still working.
New doc has me taking Effexor and Lamictal. They have resulted in leveling my reactions/mood. Most of the depression signs are gone.

I also believe that Apnea played a large part in my well-being, including the depression. I could sleep 12 hours easily!! Now, whatever I get seems to be sufficient.

My family doctor told me that she's learned to ask about sleep habits whenever a patient talks about being tired all the time.

Yes, we've 'lost' part of our lives in the quality department, but we DID manage to work around it somehow - some people don't/can't. I think that shows at least some sign on internal fortitude.

I believe that the Apnea was the underlying problem, although the clinical depression is just as real, but with sleep therapy, it is not as severe.

[byront]

SleepyHibiscus - All of your symptoms point to sleeping disorder, a classic case. Seems that your doctor should have jumped on that first. Isn't it a shame that they so easily push the drugs instead of seriously attempting a proper diagnosis. After 15 years someone should have picked up on the possibility of a sleeping disorder, especially given the symptoms you described. I just went through a terrible bout with an ear infection. I went through three doctors and not one of them checked my sinuses or bothered to even try to discern the cause of the problem – just pushed pills. I know that I have a sinus problem but currently can't afford to go back to an ENT specialist, and I didn't have much luck with my last one - he almost killed me - twice! I think (and hope) your finally on the right track though. I had all the same symptoms you have and have been definitely seeing improvement. I still don't have the energy level that I would like and still feel kind of tired a lot of the time, but I think that once I get an exercise program rolling and have stuck with it for a while it will get much better. I used to fall asleep in a snap when I sat for a while or after a meal, I used to even take naps in my truck from time to time. Now, even though there are many times when I seem to want to take a nap, I can't. I just can't seem to fall asleep. I used to wake up three, on the average, and sometimes four times a night to go to the bathroom - not at all now. I usually wake up about twice a night now, sometimes three times if I have a mask leak and I need to adjust - much less than I used to. One of the nicest benefits is that I have only had three morning headaches since I started on cpap, and two of those I would consider minor compared to what I used to get. I used to wake up with one almost every morning (at least 5 days a week) that would last all day unless I downed at least 7-8 ibuprofin (which I know was bad for me but it was the only thing that work). I very seldom take ibuprofin anymore, which is another big plus. I have only been on cpap for just under a month now and feel very fortunate that I was able to adjust very easily to it (I had good luck with my mask and minor lights and sounds don't bother me at all). I'm thinking that bumping into your nurse therapist may not have been just a coincidence - you've obviously been through the ringer and deserve some recovery. Since it looks like you have not gotten your equipment yet I would advise giving that some careful thought and not just accept anything offered. It can’t be stressed enough how important it is to investigate and be involved in your own therapy. I am hoping that you will have as good luck with your cpap therapy as I have. Best wishes to you. -- BT

[NeurosurgeryNP]

I suffered through the same problem. I have had symptoms of OSA for as long as I can remember - probably over 15 years now dating back to my first year in college. I have always been worked up for hypothyroidism as well as other problems. Never had an answer. After 9/11, my symptoms became paticularly severe - depression, sleeping all of the time, naps - 3 hours per day, and brain fog. I also had many symptoms of ADD - fidigety, etc. Yes, I was depressed (I lost a friend in 9/11), but frankly, the whole nation was depressed.
I was started on Paxil and this did little for my sleeping issues - 10 hours per night and right before I was diagnosed, this 10 hour sleep was sandwiched with a 3 hour nap every day. I continued on the PAxil to no avail. My thyroid studies were all OK (I am on Synthroid).
I kept complaining to my PCP, and eventually kept mentioning it to my pulmonologist whom I see for my asthma. So he said - I don't think you have sleep apnea, but we will send you for a test.
And - wah la - I have OSA - gratefully - because I was very close to going to a shrink - what I was doing was not normal behavior in any way.
So, I started on CPAP in March 2005. Within 3 days, I had some noticable difference in my wakefulness during the day and within 1 month I was taking about 1 nap per week. One month later, I was weaned off my Paxil. My depression resolved and my brain fog disappeared.
Here I am now 1 1/2 years later. My future husband (in 16 days we will be married) also has OSA - I called and made the appointment for him, becasue after 2 years of hounding, he wouldn't do it - and he too now is a different person.
I am so blessed to have a diagnosis - and an easy one at that - sure, we are stuck with a machine every night, but it could have been cancer, or MS - you get the idea. I am blessed that I am on treatment and that I have my life back. I NEVER want to feel that way again. I have been 100% compliant, 100% of the time.

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